Provider Demographics
NPI:1477744621
Name:POLOVICH, MARTHA (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:POLOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TOWER BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2563
Mailing Address - Country:US
Mailing Address - Phone:919-419-5051
Mailing Address - Fax:919-493-3234
Practice Address - Street 1:3100 TOWER BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2563
Practice Address - Country:US
Practice Address - Phone:919-419-5051
Practice Address - Fax:919-493-3234
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 109632163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology